For colonoscopies, 45 is the new 50 in the U.S.

Dropping the age requirement by five years will allow millions of people to get screened earlier, and save countless lives.

Dave Yasvinski 4 minute read May 19, 2021
colorectal cancer screening

New guidelines suggest people who are at average risk should be screened at 45, not 50. Getty

There’s no time like the present when it comes to colorectal cancer, according to a group of experts that recommends screening individuals of average risk for the disease at the age of 45 — five years earlier than the previous standard.

The change, published in an editorial in the current issue of JAMA, comes amid rising rates of early onset of the disease and brings the U.S. Preventive Services Task Force (USPSTF) in line with similar guidance from the American Cancer Society. The move by the task force, an independent panel of specialists funded by the U.S. Department of Health and Human Services, means U.S. health insurers will be required to pay for preventative procedures related to colorectal cancer, such as colonoscopies and stool sample testing, at no cost to patients.

“A concerning increase in colorectal cancer incidence among younger individuals (i.e., younger than 50 years; defined as young-onset colorectal cancer) has been documented since the mid-1990s, with 11 per cent of colon cancers and 15 per cent of rectal cancers in 2020 occurring among patients younger than 50 years, compared with five per cent and nine per cent, respectively, in 2010,” said Kimmie Ng, the first author of the editorial.

While rates of colorectal cancer have been decreasing among people aged 50 and older, they’re moving in the opposite direction for patients under the age of 50 and it isn’t clear why, said Ng, who is also is the director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute. Dropping the age requirement by five years will allow millions of people to get screened earlier, saving countless lives, she said.

Colorectal cancer is the third-most diagnosed cancer in Canada, with just under 27,000 new cases arising in 2020, according to the Canadian Cancer Society. It is the second leading cause of death from cancer in men and third in women. Roughly 73 Canadians receive the grim diagnosis — and another 27 succumb to the disease — every day.

The task force settled on the age of 45 because research reveals the five-year head start will prevent more deaths while introducing minimal increases to potential colonoscopy complications. The task force still recommends selectively screening people between the ages of 76 and 85 because more rigorous testing produces relatively small increases to the lifespan of this age group.

With cases of colon cancer in people aged 20 to 29 years old rising by two per cent each year, and rectal cancer rates up 3.2 per cent among those aged 20 to 29 years old and 30 to 39 years old, the group mulled lowering the age requirement further.

“We are now seeing patients even younger than 45 — in their 20s and 30s — who are being diagnosed with this cancer and often at very late stages,” Ng said. “Clearly the USPSTF recommendation to start screening at age 45 will not be enough to catch those young people who are being diagnosed.”

Detection and prevention of the early onset of the elusive disease will require more research into its underlying causes, with some recent avenues of study focusing on dietary habits in general and sugary soda in particular. It will take “bold steps” to ensure the five-year window produces significant decreases to the occurrence and mortality rates of the disease, the editorial said, calling for public awareness campaigns to ensure people are aware of the benefits of the procedure. The authors also noted that only 68.8 per cent of eligible adults in the U.S. get screened.

“Given the sizeable gaps in colorectal cancer incidence and mortality between Black adults and white adults in the U.S., quality metrics must specifically examine performance in the Black population and undertake interventions necessary to eliminate disparities,” the editorial said. “Communicating the morbidity and mortality attributed to colorectal cancer in the Black community, including the recent death of actor Chadwick Boseman at age 43, has potential for increasing awareness.”

Dave Yasvinski is a writer with

If you or someone you care about is living with cancer, connecting with a support network can help to not only learn ways to better manage their health, but also share experiences with others. Some Canadian resources include the WellspringCancer Connect at the Canadian Cancer Society, and Colorectal Cancer Canada.


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